Shared Flashcard Set

Details

RN Nursing Care of Children- Respiratory Illness
ATI Review 2010
49
Nursing
Undergraduate 4
03/03/2013

Additional Nursing Flashcards

 


 

Cards

Term
Overview: Common Respiratory Illnesses
Definition
1. DO can affect upper respiratory tracts:
-nasopharynx, pharynx, larynx, upper trachael

2. DO can affect lower respiratory tracts:
-lower trachea, mainstem bronchi, segmental bronchi, sugmental bronchioles, terminal bronchioles, and alveoli
Term
T/F Infections of respiratory tract may affect more than one area
Definition
TRUE
Term
Infectious agents include:
Definition
1. Group A B-hemolytic streptococci (GABHS)
2. Respiratory synnctial virus (RSV)
3. Haemophilus influenzae
4. Streptococcuspheumoniae
5 Mycoplasma pneumoniae
Term
Infants between 3-6 months of age are at an increased risk of respiratory illness. WHY?
Definition
D/t decreased maternal antibodies acuqired at birth and lack of antibody protection
Term
Viral infections are more common in what age group?
Definition
-Toddlers and preschoolers
-Indicidences of these infections decreases by age 5
Term
What infectious agents increase in rate after age 5?
Definition
GABHS and Mycoplasma pneumoniae
Term
T/F Certain viral agents can cause serious illness during infancy, but will only cause mild illness in older children
Definition
TRUE
Term
Anatomical Risk Factors r/t common Respiratory Illness
Definition
1. Short, narrow airway
(easily obstructed with mucus or edema)

2. Short respiratory tract
(allows infections to travel quickly to lower airways)

3. Infants and young children have small surface areas for gas exchange

4. Infectious agents have easy access to middle ear through short and open eustachian tubes of infants an young children.
Term
Risk Factors of Common respiratory Illnesses
(Decreased Resistance d/t: )
Definition
1. Compromised immune system
2. Anemia
3. Nutritional Deficiencies
4. Allergies
5. Chronic Medical conditions
(asthma, cystic fibrosis, CHD)
6. Exposure to second hand smoke
Term
Children with ASTHMA have a greater incidence of respirator infections during ______ weather.
Definition
cold
Term
RSV and other common infections are more common during _____ & ____.
Definition
Winter and spring
Term
Infections caused by Mycoplasma pneumoniae are more frequent during ____ & _____
Definition
Autumn and early winter
Term
Subjective Data r/t Common Respiratory Illnesses
Definition
Nursing Hx:
-recent infections
-medications
-immunization status
-family coping
Term
(Common Cold)
-self limiting virus that persist for 7-10 days

S/S
-nasal inflammation
-rhinorrhea
-cough
-dry throat
-sneezing
-nasal qualities heard in voice

-Fever, decreased appetite, irritability
Definition
Nasopharyngitis
Term
S/S of What Respiratory Illness
-inflamed throat with exudate, pain with swallowing

-HA, Fever, abdominal pain

-Cervical lymphadenopathy

-Truncal, axillary, and perineal rash
Definition
Pharyngitis (Strep Throat)
c/b GABHS
Term
Persistent cough as a result of inflammation: ______
Definition
Bronchitis (Tracheobronchitis)
-associated with URI and inflammation of large airways
-self limiting and requires symptomatic relief
Term
S/S of Bronchiolitis
Definition
-Rhinorrhea -
-pharyngitis, intermittent fever, cough, wheezing

-Cough that progresses toward wheezing, increased RR, nasal falaring, retractions and cyanosis
Term
Bronchiolitis
Definition
-most commonly caused by respitatory synctical virus (RSV)
-primarily affects bronchi and bronchioles
-occurs at the bronchiolar level
Term
Bronchiolitis is most commonly caused by ____
Definition
RSV
Term
T/F Allergic rhinitis is caused by seasonal rxn to allergens most often in the autumn or spring
Definition
TRUE
Term
S/S of allergic rhinitis
Definition
1. Watery rhinorrhea
2. Nasal congestion
3. Itchiness of nose, eyes, pharynx
4. Nasal quality of voice
5. Dry scratch throat
6. Poor sleep --> poor school performance
7. fatigue
Term
T/F Bacterial epiglottis (acte supraglottis) is a medical emergency
Definition
TRUE
Term
Bacterial epiglottis is c/b ____
Definition
Haemophilus influenzae
Term
Bacterial Epiglottis (Croup Syndromes)
Definition
1. Sitting with chin pointing out, mouth open, tongue protruding
2. Drooling
3. Anxiety with respiratory distress
4. Absence of spontaneous coughing
5. Dysphonia (hoarseness or difficulty speaking
6. Dysphagia
7. Inspiratory stridor (noisy inspiratioons(
8. Sore throat, high fever, restlessness
Term
S/S of acute laryngitis
Definition
Self limiting viral infection.

-hoarseness as only symptom
Term
s/s of acute laryngotracheobronchitis
Definition
-low grade fever, restlessness, hoarseness, barky cough, inspiratory stridor, retractions
Term
Causative agents of Acute laryngotracheobronchitis
Definition
-RSV
-influenza A and B
-mycoplasma pneuomoniae
Term
S/S of Acute Spasmodic Laryngitis
Definition
-Self Iimiting Illness that may result from allergens

-barky cough, restlessness, difficulty breathing, hoarseness, nighttime episodes of laryngeal obstruction
Term
LAB tests for respiratory illlnesses
Definition
1. Throat culture for GABHS
2. Blood samples;
-Elevated ASO titer
-Elevated C-reactive Protein (CRP) or sedimination rate in response to an inflammatory rxn
3. CBC to assess anemia and infection
4. Sputum culture and sensitivity to detect infection
Term
Dx procedure to Detect RSV
Definition
-Collection of direct aspiration of nasal secretions
- Collected for immunofluoresence analysis

1. 1-3 mL of NS is instilled into child's nostrils , fluid is then aspirated for evaluation
2. Placce pt in SUPINE position
3. use sterile syringe w/o needle

Teach:
-potential need for isolation, dependent on results of lab test
Term
Dx test for pneumonia
Definition
Chest X rays identifies infiltrations in PNA

-ensure child is positioned correctly to avoid need for repeat x ray

TEACH
-need confirmation of nonpregnant status of adolescents of childbearing age
Term
T/F Tongue depressors and taking a throat culture should be used if epiglottis is suspected.
Definition
FALSE
do NOT attempt to use.
Term
What is used to help mobilize and remove fluid from the lungs? ___ & ___
Definition
postural drainage and/or chest physoptherapy (CPT)
Term
Epinephrine
Definition
-Vasoconstriction of submucosa and to decrease edema

Raceemic epiniephrine via nebulizer
Alpha receptor stimulation - Administer for vasconstriction of submucosa and decrease edema
Beta receptor stimulation - bronchiodlation, reduction in airway smooth muscle spasms

2. Observe child for 3hrs after administration

TEACH
-inform child may feel acceleration in HR during administration

*Administer via nebulizer racemic epinephrine
Term
Corticosteroids
Dexamethasone (Decardone)
Budesonide (Rhinocort)
Definition
-Administer to decrease inflammation

-Administer orally via nebulizer OR IV route

TEACH
-assist child to rinse mouth afer nebulizer tx
Term
Antipyretics, Mild Analgesics, Antibiotics
Definition
other medications for resp illness
Term
Care after Discharge (Resp Illness)
Definition
1. Cool-air vaporizer to provide humidity
2. Rest during febrile illness
3. Maintain adequate fluid intake
(infants - oral rehydration solutions; older - sports drinks)
4. Limit use of nose drops/sprays to 3 days to prevent rebound congestion
5. Ice bag or heating pad to neck to decrease pain from enlarged cervical nodes
Term
T/F Ice bag or heating pad to neck to decrease pain from enlarged cervical nodes can be used for resp illness
Definition
True
Term
Limit use of nose drops or sprays to 3 ays to prevent
Definition
rebound congestion
Term
Airway obstruction
Definition
-result from progression of resp infectious process or foregin body aspiration
Term
Position of child during airway obstruction
Definition
1. Ensure proper body alignment
2. Prone, semiprone, side liying to promote lung expansion & gas exchange, prevent aspiration
Term
Suctioning of airways limited to ___attempts
Definition
5
Term
T/F Examine a child's throat with a tongue blade or take a throat culture if epiglottis is suspected
Definition
FALSE
Term
S/S of Respiratory Distress
Definition
Increased HR and RR
-Nasal Flaring
-Chest retractions
increased restlessness
Term
Function of tonsils
Definition
Tonsils are lymph-type tissue found in pharyngeal area

-Primary role to filter pathogenic organisms (viral and bacerial) to protect resp and GI tract.
-Play a role in formation of ANTIBODIES
Term
Diversional activities for a school-aged child following a tonsillectomy
Definition
-watch a movie
-play a board game
-put a puzzle together
-play cards
-read a book
-visit with a friend/family member
-color a picture
-play a video game
-make a craft
Term
A nurse is caring for a child who is in post-op period following a tonsillectomy. When assessing the child the nurse should recognize which findings as a consistent sign of post-op bleeding?
Definition
frequent swalowing and clearing of throat.

-restelessness, bright red emesis, tachycardia, pallor

Expected findings: inflammed, reddened throatl blood tinged mucus
Term
Nursing interventions included in post op care following a tonsillectomy
Definition
1. Avoid red-colored liquids and milk based foods initally
-Clear liquids and fluids encouraged AFTER return of gag reflect

2. Addvance to soft bland foods
3. Discourage child from coughing, thraot clearing, nose blowing to PROTECT surigcal site
4. Position child on side to facilitate drainge/elevate HOB if fully awake

5. Blood tingued mucus or clots is expected in vomitus (teach parents)
Term
Manifestations of bacterial epiglottis
Definition
1. Hoarseness and difficulty speaking (dysphoria)
2. Difficulty swallowing (Dysphagia)
3. Drooling
4. Stridor
5. HIGH grade fever
Supporting users have an ad free experience!